Dibiraliev Ch D, Abdulaev Ch N, Danilov S P, Dymov A M, Sukhanov R B, Bezrukov E A
Institute for Urology and Reproductive Health, I.M. Sechenov First Moscow State Medical University, Moscow, Russia.
Urologiia. 2024 Jul(3):57-62.
Several techniques are used for laser enucleation of benign prostate hyperplasia, including two- and three-lobe enucleation, enucleation of all lobes in a single block (en-bloc), and enucleation of all nodes in a single block without longitudinal incisions (total en-bloc).
A prospective and retrospective analysis of the results of two-lobe, en-bloc, and total en-bloc using thulium fiber laser enucleation of the prostate (ThuFLEP) techniques was performed.
s. The study included a retrospective and prospective comparative analysis of the peri- and postoperative results of ThuFLEP using several techniques. Patients with benign prostatic hyperplasia causing bladder outlet obstruction (IPSS>20, Qmax<15) were undergone to ThuFLEP from January 2015 to May 2022. All patients were examined prior to and 1, 3, and 6 months after the procedure. In the pre- and postoperative period, the age of the patients, prostate volume, level of prostate-specific antigen, functional parameters (IPSS, post-void residual, Qmax, and QoL), the stress urinary incontinence were evaluated. In addition, the following intraoperative parameters were assessed: duration of the procedure, enucleation rate, morcellation rate, and mass of enucleated tissue.
We found 450 patients who underwent thulium fiber laser enucleation of prostate hyperplasia (ThuFLEP). Three laser enucleation techniques were used, including two-lobe (n=148; group A), en-bloc (n=150; group B), and total en-bloc without longitudinal incision (n=152; group C). The mean prostate volume was comparable between groups. The mean operation time for the total en-bloc technique (group C) was less compared to the other two techniques (58.9+/-30.1 vs. 68.8+/-30.6 for group A and 67.4+/-30.1 min for group B, respectively; p<0.005). The mean enucleation rate in group C was higher compared to groups A and B (2.3+/-0.78 vs. 1.9+/-0.74 and 1.9+/-0.69 g/min, respectively; p<0.005). The mean morcellation rate in all three groups was comparable (2.8+/-1.7, 3.0+/-1.1, and 2.9+/-2.1 g/min; p>0.05). After 6 months, there were no differences in functional results, according to the IPSS, PVR, Qmax, and QoL.
The two-lobe, en-bloc, and total en-bloc techniques were comparable in functional results and the complication rate. Total en-bloc enucleation showed the higher enucleation efficiency.
用于良性前列腺增生激光剜除术的技术有多种，包括两叶和三叶剜除术、整块剜除所有叶（整块剜除）以及不做纵向切口整块剜除所有结节（完全整块剜除）。
对使用铥光纤激光前列腺剜除术（ThuFLEP）的两叶、整块和完全整块技术的结果进行前瞻性和回顾性分析。
该研究包括对使用多种技术的ThuFLEP围手术期和术后结果进行回顾性和前瞻性对比分析。2015年1月至2022年5月，对因良性前列腺增生导致膀胱出口梗阻（国际前列腺症状评分>20，最大尿流率<15）的患者进行ThuFLEP手术。所有患者在手术前以及术后1、3和6个月接受检查。在术前和术后阶段，评估患者的年龄、前列腺体积、前列腺特异性抗原水平、功能参数（国际前列腺症状评分、残余尿量、最大尿流率和生活质量）、压力性尿失禁情况。此外，评估以下术中参数：手术持续时间剜除率、碎切率和剜除组织质量。
我们发现450例接受铥光纤激光前列腺增生剜除术（ThuFLEP）的患者。使用了三种激光剜除技术，包括两叶剜除术（n = 148；A组）、整块剜除术（n = 150；B组）和无纵向切口的完全整块剜除术（n = 152；C组）。各组间平均前列腺体积具有可比性。完全整块技术（C组）的平均手术时间比其他两种技术短（分别为58.9±30.1分钟，A组为68.8±30.6分钟，B组为67.4±30.1分钟；p<0.005）。C组的平均剜除率高于A组和B组（分别为2.3±0.78克/分钟，A组为1.9±0.74克/分钟，B组为1.9±0.69克/分钟；p<0.005）。三组的平均碎切率具有可比性（分别为2.8±1.7、3.0±1.1和2.9±2.1克/分钟；p>0.05）。6个月后，根据国际前列腺症状评分、残余尿量、最大尿流率和生活质量，功能结果无差异。
两叶、整块和完全整块技术在功能结果和并发症发生率方面具有可比性。完全整块剜除术显示出更高的剜除效率。
